51

Climate Change and Health and Heat Wave Mortality in India
Rais AKHTAR
National Fellow, CSRD, Jawaharlal Nehru University,
New Delhi 110067, Indiae-mail: raisakhtar@gmail.com

Abstract
The paper highlights the growing concern of the impact of climate change and variability including
rainfall anomaly, rising temperature in mountain areas and occurrence of heat waves in relation tohuman mortality pattern in India. The paper investigates the historical perspective of rainfall andmalaria relationship, and cited current studies to show how climate change and variability resulted inlarge scale human loss in India. Based on data on rainfall pattern in the desert part of Rajasthan, thepaper argued that the rainfall pattern is changing. However, the summer monsoonal rainfall of 500 mm
and above may be taken as an indicator in forecasting malaria outbreak in the Thar Desert. The paper
also argued that global warming has resulted in increased heat wave conditions in India and accordingly
resulting in increased deaths due to heat wave conditions in different parts of India, particularly in thenorthwestern, south, and southeastern regions.
Key words: climate change, flooding, heat waves mortality, malaria, rainfall anomaly

1. Introduction
Global climate change generally have both positive
and negative impacts on human health. Rainfall anomaly and heat wave condition play an important role incausing ill health in various ways. Though on a global
scale changes in precipitation and temperature patterns are now well established. In India too, there isrealization that climate change is a phenomenon thatcannot be ignored. Rainfall variability in relation tothe outbreaks of malaria had been documented in a
number of studies. Similarly, the rise in heat wave
mortality in India over space and in time indicate thechanging environmental condition in India. Global
warming could lead to severe droughts affecting agriculture and to leave forests and coastal areas vulnerable. The projected climate change scenarios indicate
increase and variable trend of both rainfall and temperature into the 21st century. The initial analysis hasrevealed that climate change may have adverse effects
in terms of severity of droughts and intensity of floods
in various parts of the India.

2. Rainfall and Malaria: 19th Century
Observations
Based on 1869 data, Macnamara (1880) provided
an account on climatic conditions and malaria outGlobal Environmental Research
11: 51-57 (2007)
printed in Japan

breaks in northern and western India. It is surprising
to note that Christopher and Sinton (1926) who prepared a malaria map of India (Christopher, 1911) havenot mentioned this pioneering attempt by Macnamara.
Macnamara noted, at several stations, in the upper
Gangetic plains and in the Punjab as well as in Bengal,
the rise in the number of admissions for fever is very
marked during July and August, the most equably
months in respect to temperature of the year and theadmissions attain their maximum frequency in September. He further observed that probably, throughout
Bengal, much of the northwest provinces, and parts of
the Punjab, the average rainfall quite suffices to foster
as abundant.
Table 1 shows monthly mortality figures due tomalaria as reported in northern and western India. It is
indicated that mortality rises with increase in rainfall,with maximum in October and declines from November onwards. Macnamara (1880) quoted Surgeon J.R.
Johnson, who stated that it was in fact pure malarious
fever, and probably caused, or at any rate greatly
Table 1 Fever deaths in Northern and Western India.
(Macnamara, 1880)
1869

July

AugustSeptember

OctoberNovemberNumberof deaths

13,734

15,59531,30744,22136,332©2007 AIRIES

52

Rais AKHTAR

aggravated by late and heavy rains. A most decided
increases in the number and severity of the attacks
was observed about/on September 20, and from thatdate to the end of October the disease was at its work.
Thus Hehir (1927) has rightly postulated that, ingeneral terms it may be stated that malarial fevers aremost prevalent in India during the years of the heaviest monsoon rains, there are the years in which we getoutbursts of high endemicity and this is particularly
the case in the level plains, and localities in which thedrainage is slow or in any way obstructed. In the context of Thar Desert, poor drainage obstruct flood.

3. Environment and Health in India– Malaria, Cholera and Other Deseases
Although not many studies concerning environment and health dimension were conducted, still anumber of investigations focused on various environmental factors in relation to disease occurrence inIndia with a major thrust on malaria (Gill, 1923, 1931,
1933).
A significant study was undertaken by Learmonth(1957) who studied the regional geography of malaria
in Indian-subcontinent, with an identification ofendemic and epidemic zones of malaria.
Banerjee and Hazra (1974) examined geoecological factors in relation to cholera in West Bengal.
Akhtar and Learmonth (1977) focused on the resurgence pattern of malaria in India during 1965-1976,
and studied the diffusion pattern from the environmentally different four foci regions. Temperature and rainfall were studied in relation to the occurrence of diseases in India by Akhtar (1979) with particular reference to malaria and waterborne diseases.
Hyma and Ramesh (1980) highlighted the reappearance of malaria in Sathanur reservoir and environs: Tamil Nadu India, and Dutt, et al. (1980) concerned with the incidence of malaria in two west
central states of Gujarat and Madhya Pradesh. Akhtar(1980) in his book “Environment, agriculture andnutrition in Kumaon region” examined the interrelationship between environmental factors and level ofagricultural production and availability of nutrition ina mountain region of Kumaon.
Ramachandran (1984) presented the findings on
the relationship between some environmental elements and incidence of influenza, fever, dysentery,asthma, tuberculosis and typhoid in rural areas ofTumkur district, Karnataka. Akhtar and Learmonth(1985) edited a book “Geographical aspects of healthand disease in India,” which comprises case studies
on environmental set up of malaria, goitre, smallpox
and guinea worm disease. Choubey (1985) studied theincidence of diseases in Sagar city in central India as aconsequence of environmental and nutritional factors.
Bouma (1995) and Bouma et al. (1995) reported
the epidemic malaria in northern Pakistan and in Thar
Desert, respectively. Sharma (1955) noted malaria

menace.
Mathur (1991) examined the higher concentrationof fluorides in the soils of eastern part of Indian desert
zone with implications of flourosis, and Akhtar and
McMichael (1996) assert that both the heavy rainfall
and the number of rainy days were associatedpositively in the outbreaks of malaria in desert regionof Rajasthan in 1994. Mathur and Panghaal (1998)
conducted their study on the geographical correlatesof tuberculosis in Haryana state.
Akhtar (2004) traced the historical perspective ofenvironmental scenario and diseases in Kashmir during late 19th century. In a joint study, Dutt et al.
(2006) reexamined the outbreak of plague in Suratcity in 1994 in the background of flooding, insanitaryconditions, and environmental deterioration.
In a recent study on the impact of climate variability on vector borne diseases, Dhiman (2007) assertsthat meteorological parameters, changes in ecologicalconditions, development of resistance in Plasmodium
falciparum parasite and lack of surveillance are thelikely reasons. Dhiman opined that the outbreaks ofdengue and chikungunya are also associated withclimate variability.

4. Changing Rainfall, Floods, Irrigation
Canals
4.1 Rainfall changing pattern in the Thar Desserts
It is worthwhile at this stage to study the changing
rainfall pattern in the desert region. Goudie (1983),
who studied the changing rainfall pattern in arid areas,
including the Thar Desert, noted changes in rainfall
1890 to 1895. Conditions had been relatively wet in
the 1880s and 1890s. In these periods, June - September summer monsoon rainfall was 2,422 mm, but
2,472 mm in 1891-1900. There followed a period of
low precipitation: that is precipitation in the driest
decadal period was generally only between 52% and
69% of that for the wettest decade of this century. The
decreases in the summer rainfall was also noted
during 1957-1970. The analysis of data for Bikaner
and Jodhpur of Thar Desert showed that summer monsoon rainfall decreased steadily by more than 45%
since 1957 as shown in Table 2.
Analysis of data of flood years in the desert region
during the period of 123 years since 1871 showed that
only five years (flood years) recorded summer monsoon rainfall above 500 mm (Parthasarathy, 1987).
These years were 1908 (573 mm), 1917 (564 mm), 1944
Table 2 Five year running mean percentage of
normal summer monsoonal seasonalrainfall centred on 1957 and 1970.
(Source: A. Goudie (1983))

1957

1970

Bikaner

114

71

Jodhpur

115

68

Climate Change and Health and Heat Wave Mortality in India(542 mm), 1990 (777 mm) and 1994 (544 mm), 1994
being the year of the last malaria outbreak in theregion. Similarly malaria was also reported inepidemic form during 1990 flood year. The summer
monsoonal rainfall of 500 mm and above may betaken as an indicator in forecasting malaria outbreakin the Thar Desert.
4.2 Irrigation canals
The construction of canals in the desert area commenced in 1962, and the first phase was completed in
1990. By this time there was a network of canals witha total length of more than 8,000 km. These canals
have created water logging problem in vast areas. As aresult of irrigation facilities soil structure has beenchanged with increased moisture retaining capacity.
As a result of these environmental changes (manmade), a new vector (Anophelese culicifacies) is expanding in this areas, which was earlier dominated by
A. stephensi. A. culicifacies remains active throughout
the year. Such environment must have contributed in
the increased incidence of malaria in the Thar Desert.
However, the outbreak of malaria in the region,
particularly in 1994 can not be associated with thechanged environment due to canal irrigation network.
Anomalously heavy rainfall due to El Niño Southern
Oscillation created flooding conditions. And poor
drainage in the Thar Desert resulted in the creation ofbreeding places. This has caused both high morbidity
and mortality in 1994. In 1993, there were 354 deaths
in India attributed to malaria. However, in 1994, some372 deaths were officially reported in the four districtsof Thar Desert, which accounts about 0.6% of India’s
population.
It should also be noted that the state of Punjab
which has about 2.4% of India’s total population with
98% irrigated cultivated area reports only 185 cases of
Plasmodium falciparum with no death, compared with
88,310 P. falciparum cases with 452 deaths in the stateof Rajasthan. Thus the hypothesis that the canal irrigation and water logging were the main reasons formalarial outbreak does not prove empirically.

53

5. Examples
5.1 In the Thar Dessert in 1982-1994
Based on thirteen years data, attempt has been
made to study the association between rainfall conditions and the incidence of malaria. Table 3 shows thatboth the total annual rainfall and the number of rainydays are positively correlated with the total positive
cases of malaria in the epidemic years of 1983, 1990
and 1994. Thus the hypothesis of meteorological correlation is proved positively (Akhtar & McMichael,1996).
Attempt has also been made to correlate the average November temperature (Average of mean minimum and maximum in November) with the incidenceof P. falciparum cases during 1982-1994. The correlation has been negative, as there is hardly any positive
correlation in any year except during 1988 and 1989.
Regarding the epidemic correlation with the rainfall in
1994, it should be noted that the total monsoon rainfall (June - September) in the year 1994, was one of
the four years which experience the highest rains since
1871 (other years being 1917, 1944, 1990). Since
1982, the highest number of rainy days occurred (thatis 51) only in 1994. Therefore the contention of Tyagi
et al. (1995) that the epidemic occurred in the desert
region irrespective of high rainfall does not hold significance. Hehir (1927) in his book “Malaria in India”
published in 1927, noted the desert region withmoderate epidemic zone (Hehir, 1927). He further said
that malaria is markedly seasonal in character (usuallymaximum in autumnal) and moderately prevalent.
However, Trent (2002) points out that, althoughmalaria is preventable, there are a number of factorsthat hinder the successful control of the disease in
India. While climate can affect the incidence ofmalaria, it is increasingly clear that man’s economic
activities and malaria control strategies play a farlarger role in the incidence of the disease.
5.2 Heat wave mortality
The phenomenon of heat wave, its frequency andintensity causes serious illness and death. According
to Intergovernmental Panel on Climate Change (IPCC,

Table 3 Rainfall, rainy days and incidence of malaria in Jodhpur.
1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

Average November
temperature (°C)

24.0

21.0

23.0

24.5

24.0

24.6

23.2

24.2

23.0

23.0

22.4

24.1

22.7

Total annual rainfall
(mm)

417

513

231

214

249

111

270

230

844

204

526

326

595

Number of rainy days

36

41

21

20

17

16

38

28

44

25

27

29

51

Total malaria cases

1,509

5,934

4,803

2,918

1,034

399

2,877

6,011 10,462 6,374

9,685

3,096 14,919

Percentage ofP. falciparum cases tototal cases

15

25

9

10

11

7

9.5

23

48.3

26.0

28.7

16.3

64.2

54

Rais AKHTAR

2001) an increase in the frequency or intensity of heatwaves will increase the risk of mortality and morbidity,
primarily in older age groups and the urban poor,
particularly living in slums or squatter settlements.
In India, heat waves events and consequent deaths
have been increasing year after year. In 1981 there
were seven heat wave days with 63 deaths. Thesefigures rose to 27 events and 1,658 deaths in 1998,
and 70 events and 1,539 deaths in 2003.
According to World Health Organization (WHO,1999) more then 4,000 farmers died due to heat waves
since 2000; 1,200 in 2002, 2,400 in 2003, 200 in 2005
and 50 in 2006. In 1998, Orissa alone recorded 2,000
deaths due to heat waves leading to dehydration andheat strokes (Economic Times, 2007).
Based on the global climate, the first six years
among the warmest years of past 140 years are fromthe recent decade (1998, 1997, 1995, 1990, 1999,
1991). The observed increase in the frequency of heatwaves and severe heat waves actually and their persistency during 1990-2000 might have resulted from theincrease in the decadal scale of global warming (Pasiet al. 2004).
Prominent among the studies on heat wave
mortality was the paper by De and Mukhopadhyay(1998). These authors had examined severe heat wave
conditions over the subcontinent in 1998 and assertthat during the period March-June, when the normal
temperatures are generally high over the Indian subcontinent, any further rise in temperature becomes amatter of concern to all the people. Each spells of hightemperature sometimes claim heavy toll of human
lives as well as live stock. The 1998 severe heat wave
condition initially prevailed over northwest India. It
then extended south and southeast towards Orissa andcoastal Andhra Pradesh De and Ray (2000) reported
these problems in the megacities.
An analysis of data on heat wave deaths reveals
that the number of heat wave events and consequentmortality are on rise. These figures of mortality rose to
2,098 and 2,441 for the period 1979-1988 and1989-1998 respectively and 3,023 for the period
1999-2004 as shown in Table 4.
Table 5 and Fig. 1 show the number of heat wave
deaths for the period 1979-2004. It is evident from thetable and the figure that in general the number ofdeath have increased.
The severe heat wave condition of 1998, which
was an El Niño year, initially prevailed over NW India.
It then extended south-southeast towards Orissa andcoastal Andhra Pradesh (De & Mukhopadhyay, 1998)

During the month of March the heat wave conditions
prevailed on three days in Jammu and Kashmir, 1 dayeach in west Rajasthan, Konkan, Goa and northinterior Karnataka. This was the first time that day
temperatures were 3 to 4 degrees appreciably above
normal on 3 to 5 days in hills of west Uttar Pradesh,(now Uttrakhand), Jammu and Kashmir, Rajasthan,
Saurashtra and Kutch, Rayalaseema, Tamil Nadu andKarnataka, on 1 and 2 days in Assam and Meghalaya,west Madhya Pradesh, Gujarat region and Maharashtra
during the second fortnight of the month. The highest
mortality was reported in 1998, i.e. 1,658 deaths. The
major chunk was from Andhra Pradesh (514), Orissa(320), Rajasthan (322) and Bihar (161). During themonth of May, about 1,579 people lost their lives inmany parts of the country, according to a report by the
India Meteorological Department (IMD, 1999).
Table 5 Heat wave deaths in India (1979-2004).
Year
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004

Number of Deaths
365
106
63
11
185
58
141
155
90
924
43
2
250
114
73
234
410
17
21
1,658
126
55
70
806
1,539
117

Source: De and Mukhopadhyay (1998), updated andcorrected by the author with the help of IMD
Annual Reports on Disastrous Weather Events.

Table 4 Heat wave deaths in India.
PeriodNumber of deaths

1979-1988

2,098

1989-1998

2,441

1999-2004

3,023

Fig. 1 Heat waves deaths in India.
(Source: IMD (1999))

Climate Change and Health and Heat Wave Mortality in India

Another striking feature of analysis of heat wave
mortality data in India since 1979, that like European
Heat wave of 2003, India too suffered the second
highest mortality, i.e. 1,539 deaths in 2003 as shownin Table 5 and Fig. 1. Severe heat wave conditions
prevailed on 11 days in coastal Andhra Pradesh andon 1 to 2 days in west Uttar Pradesh, Chattisgarh,
Telangana, Rayalaseema and Tamil Nadu (IMD, 2004).
Heat wave conditions prevailed on 4 to 7 daysin Haryana, west Rajasthan, east Rajasthan, west
Madhya Pradesh and 1 to 2 days in east Uttar Pradesh,west Uttar Pradesh, east Madhya Pradesh, Gujarat
region, Saurashtra and Kutch, Vidarbha and Telangana(IMD, 2004). The largest toll was in Andhra Pradesh(1,300 deaths) followed by Orissa (141) and just 57 in
Punjab, U.P., Rajasthan, Bihar and Madhya Pradesh
together. However, the regions of Orissa, and coastal
Andhra Pradesh suffer most in terms of heat wave
mortality. Such heat wave conditions are attributed toboth physical and human factors. Physical facts like55

the blowing of north-westerly wind into the region,
absence of sea breeze from Bay of Bengal, existenceof an inversion layer in the atmosphere, rising level ofalbedo (the reflection of the surface), and numerous
manmade causes including sleeping outdoor and lackof shelter etc. Erratic power and water supply is acommon phenomenon in several states. In association
with heat island phenomena, human health in the
megacities is one of the serious problems (De et al.,1998, 2000).
Was the 2003 heat wave phenomenon a global
one? We need to analyse heat wave mortality data forother countries as well, in order to identify global heatwave mortality pattern in 2003.
5.3 Media reports on health
For the past couple of years, both television news
channels as well as newspapers in India have been
focusing on the significance of environmental change
occurring in India. Almost everyday we see one or

Fig. 2 A clipping from a newspaper dated 5 May 2007.

56

Rais AKHTAR

two reports appearing in national newspapers concerning about temperature rise with special reference toheat wave conditions both in northern and southern
India. The leading Indian newspaper ‘The Times ofIndia,’ on 20th June, 2005 captioned that heat wave
continues in East India focusing on the rise in temperatures between 44°C-47°C in Orissa. Once known
for its sublime climate, the city of Bhubaneshwar isperhaps encountering its worst summer in recent
memory in 2005. The city has registered day temperature of over 46°C thrice within June 2005 turning it
into the burning cauldron for prolonged period. The
newspaper further stated that Purulia continued to be
the hottest place (51.1°C) in West Bengal whichclaimed 23 lives in the state in the last two weeks.
Over 450 persons have fallen ill, mostly due todehydration in Purulia district. The heat wave forced
the Patna district administration to extend schools
summer vacation until June 30. Meanwhile, as manyas 30 persons have been reported dead in the last
48 hours in Uttar Pradesh in North India, with temperature 46.8°C in Varanasi, and Allahabad coming aclose second at 46.3°C followed by Lucknow at
45.7°C. The vast Indo-Gangetic plain spread across
Uttar Pradesh is literally burning. According to thisreport, the 2005 summer was one of the hottest summers in Uttar Pradesh in the last 100 years.
In another news on 25th June, 2005, the caption inthe ‘Time of India’ wrote “heat waves continues unabated in North India,” with focus on developed statesof Punjab, Haryana and Chandigarh in NW India as
the scorcher confined people indoors. The deathcounts 35. Erratic power and water supply, however,forced people to stage demonstrations against the government.
On 11th October 2005, newspaper ‘The Times ofIndia’ published a review of a WHO workshop on climate change and health, held at Mukteshwar, Almora
which highlights that climate change brings healthdangers to hills. These would include malaria, dengue,
diarrhoea, typhoid, heat waves, injuries and deathfrom more frequent glacial lake outbursts, extreme
weather events, and the unseen trauma of living withheightened risks day after day. In mountainous areas,
health systems are not geared to meet the new challenge. Some have not even begun to recognize there isa challenge and the health sector needs to be prepared.
‘The Times of India’ on 12th October 2005, quoted
WHO estimates that climate change since the 1970s
may already be causing 150,000 deaths globally eachyear. Many of those living in mountains are alreadybeginning to feel the heat.
Continuing with publication of news items related
to the impact of climate change, ‘The Times of India’on 7th June, 2006 reports that the world’s deserts areunder threat as never before with global warming
making lack of water an even bigger problem for theparched regions.
Frequent heat wave occurrence in different regionsof India has caused a serious problem. According to
the report published on 7th February, 2007 in the‘Economic Times,’ over 1,200 people died in 2002,
2,400 in 2003, 200 in 2005 and 50 in 2006 due to heatwave conditions prevalent across the Indian subcontinent. In 1998, Orissa alone recorded 2,000 deaths
due to heat wave leading to dehydration and heatstrokes. India has approached the WHO to cope withheat wave by associating with heat wave warning
system.

6. Conclusion
Forecasting of epidemic malaria has been discussed already for the Punjab region in 1946
(Swaroop, 1946). It is evident from the discussion inthis present paper that climate change will have a wide
range of health impacts. It is now being seriously realized that increased regional climate extremes such as
heavy rainfall, cyclones and droughts would lead tophysical damage, population displacement and adverse health impacts. IPCC (2001) asserts with very
high confidence that climate extremes associated withclimate change would increase the risks of infectious
disease epidemics, particularly in developing countries. As is evident malaria is still widely prevalent inIndia and an increase in temperature in the hilly/
mountainous areas, it is feared that malaria may increase altitudinally.
The rural and urban areas of Orissa, parts of Uttar
Pradesh, Bihar, Rajasthan and Andhra Pradesh, aremajor regions emerged in this paper which areaffected by heat waves almost every year resulting inhigh human mortality.
Thus in the context of climate change impact,
adaptation and mitigation, equity in resource availability has become an important issue to be incorporated
in health planning. Therefore, it is important to focus
on poverty alleviation measures, food security andsustainable environmental management. Provision ofsatisfactory housing with safe drinking water, adequate electricity supply, and hygiene/sanitation facilities can help people cope up with climate change scenario in which the occurrence of climate extremes
may not be an unusual phenomena.
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